A fine tale of of the operating room

AT FIRST glance “Dirty Work”, the debut novel from Gabriel Weston, a London-based surgeon, may not seem for the faint-hearted. Tracing four weeks in the life of Nancy, a doctor who performs abortions and who is waiting to see whether she will be disbarred from practising, it is an occasionally gory depiction of a difficult profession. But it is also well worth reading.

Ms Weston, an ear, nose and throat surgeon, first came to prominence with “Direct Red”, her memoir about the medical world which was published in 2009, six years after she qualified as a member of the Royal College of Surgeons. It was praised for its unflinching depiction of the harsher realities of working in an operating theatre: doctors, hapless and helpless, trying not to lose their nerve, the attrition of hospital shift-work with its unsociable hours and the endless suffering coming through the doors. “Direct Red” won the 2010 PEN/Ackerley prize for autobiography. “Dirty Work” is no less graphic in its descriptions, combining a lucid writing style with everyday details of carrying out surgical procedures.

The novel begins with Nancy nearly letting a patient bleed to death. The author then moves back and forth in time to describe Nancy growing up in Britain and America (as Ms Weston herself did). Ms Weston deftly suggests the reasons why Nancy fell into her particular line of surgery, and describes the unknown stresses associated with being a doctor who carries out abortions.

The strength of Ms Weston’s novel is her ability to describe the inherent paradox of surgery—how a doctor must cause pain in order to care for a patient. With cool, unsentimental prose she demonstrates that a surgeon needs a certain kind of heartlessness to ensure that the job is done. “And whichever speciality we choose, each of us has to do something ruthless to keep our patients safe. We have to forget about the human significance of the organ we are operating on.”

This detachment can occasionally tip into cruelty. One of Nancy’s mentors plucks at the poorly stitched stomach of a female patient while she is lying awake in her hospital bed, making her writhe in pain. Nancy numbly looks out of the window while performing a minor procedure, ignoring her patient’s discomfort until she realises that “it would never work for me to disengage from my patients.” Few writers capture the mentality of surgery as incisively as Ms Weston has managed to. Her experiences in hospitals are palpable on the page.

Certain aspects of the novel work less well. Outside the operating theatre, the descriptions of Nancy’s life—visiting her sister, being awkward at a party—are rather thin. And at times even Ms Weston appears impatient with her creation. But such quibbles are outweighed by the larger point of the book. By focusing on a doctor’s point of view, Ms Weston demonstrates another, more ambiguous angle to the complex issue of abortion. “Dirty Work” shows how even surgeons who agree with abortion may find it a difficult procedure to carry out.